The results from multiple studies of substance-abusing adolescents reveal that a substantial proportion of these patients manifest significant impairments in various domains of neurocognitive functioning, especially executive functioning (EF). If participation in psychosocial interventions for substance use disorders, regardless of type, is viewed as a learning situation (i.e., requiring reception of new information, integrating it into existing cognitive stores, and drawing on that information to develop and use healthful behaviors), adolescents with impaired EF are likely to have poorer treatment responses and outcomes than their unimpaired counterparts. Preliminary data support this contention. What can be done? The empirical literature with adult substance-abusing patients suggests cognitive rehabilitation can improve EF and, in turn, lead to better treatment response and outcomes. Because adolescents are in a comparatively burgeoning neurodevelopmental period in which EF processes are being developed, modified, and refined, the findings from the adult substance abuse treatment literature cannot be simply generalized to adolescents. Simply stated, substance abuse may affect teens'brains more profoundly (or at least very differently) than adults by interfering with the development of adult-level EF that, in turn, will prohibit "normal" functioning on both a personal level and within social contexts (such as treatment episodes). Thus, the primary purpose of the proposed project is to conduct a Stage IB randomized clinical trial to determine the effect of cognitive rehabilitation on treatment responses and outcomes of adolescent substance-abusing patients. Adolescent substance-abusing patients receiving treatment in a 6-month residential treatment program (N = 90) will be randomly assigned to one of three conditions: (a) computer-assisted cognitive rehabilitation (CACR);(b) a computer attention control, computer-assisted typing tutorial (CATT);or (c) treatment-as-usual (TAU). Using measures of treatment outcome (e.g., substance use, participation in outpatient care), adolescent patients will be evaluated at baseline, posttreatment, 3-month, and 6-month follow-up. During the course of treatment, participants will also be evaluated on measures of treatment response (e.g., staff and patient ratings of therapeutic involvement, length of stay in residence, discharge type). It is hypothesized that, compared to participation in CATT or TAU, those adolescent patients assigned to CACR will have higher levels of treatment response and better treatment outcomes. It is also hypothesized that the differential effects of treatment type (i.e., CACR, CATT, or TAU) on posttreatment outcomes will be partially or fully mediated by participants'differential treatment response. Following the Stage Model of Behavioral Therapy Development, this RCT is a Stage IB study. Thus, if the results of this investigation are promising, the estimates of effect size, as well as our general experiences conducting this trial, will be used to inform a comprehensive Stage II (efficacy) trial. PUBLIC HEALTH RELEVANCE: Although drinking and drug abuse among adolescents is widely recognized as a serious and long-standing public health issue, treatment efforts with this population have met largely with mixed results. It is plausible that part of the problem is that adolescent substance-abusing patients have difficulty learning new and healthful information presented during treatment. Cognitive rehabilitation (i.e., exercises designed to enhance attention, concentration, memory, and problem-solving) may help improve learning and, in turn, yield better responses and outcomes to substance abuse treatment for these particular patients.